The nurse is caring for a client with a history of liver cirrhosis. Which complication should the nurse monitor for?

Choice A reason: Promoting effective swallowing is relevant for dysphagia but not the primary goal for sliding hiatal hernia, where the stomach protrudes into the thorax, causing reflux. Preventing acid reflux into the esophagus is critical to reduce irritation and complications like esophagitis, making swallowing secondary.

Choice B reason: Preventing esophageal reflux is the primary goal for sliding hiatal hernia, as the stomach’s protrusion through the diaphragm allows gastric acid to reflux, causing heartburn and esophageal damage. Nursing actions like elevating the head of the bed and avoiding trigger foods minimize reflux, protecting the esophagus.

Choice C reason: Maintaining intact oral mucosa is unrelated to hiatal hernia, which affects the gastroesophageal junction. Reflux causes esophageal, not oral, irritation. The focus is on preventing acid reflux to protect the esophagus, making oral mucosa maintenance irrelevant to the condition’s pathophysiology.

Choice D reason: Increasing intestinal peristalsis is not a goal for hiatal hernia, which involves gastroesophageal reflux, not intestinal motility. Enhanced peristalsis may worsen reflux by increasing intra-abdominal pressure. Preventing reflux is prioritized to manage symptoms and prevent esophageal complications.

Choice A reason: Hydromorphone, an opioid, poses a significant risk of respiratory depression by suppressing the brainstem’s respiratory centers. After four days, cumulative effects increase this risk, especially in opioid-naïve patients. Monitoring respiratory rate and depth is critical to prevent life-threatening hypoxia, making it the priority assessment.

Choice B reason: Constipation is a common hydromorphone side effect due to opioid-induced reduced gastrointestinal motility. While important, it is not life-threatening like respiratory depression. Monitoring bowel function is secondary, as respiratory compromise poses an immediate risk requiring urgent intervention in opioid therapy.

Choice C reason: Skin rash is a rare allergic reaction to hydromorphone, not a primary concern after four days of use. Respiratory depression is far more critical, as opioids directly depress respiratory drive, risking hypoxia, making rash assessment secondary to monitoring respiratory function.

Choice D reason: Nausea is a frequent hydromorphone side effect, often diminishing with continued use. While bothersome, it is not life-threatening compared to respiratory depression, which can cause rapid hypoxia. Monitoring respiratory status is the priority to ensure patient safety during opioid administration.